Risk factors for oral mucositis in patients with solid tumorsunder treatment with cetuximab: a retrospective cross-sectional study

Background: This study retrospectively analyzed the risk factors for oral mucositis (OM) during cetuximab treatment. Material and Methods: We screened patients using cetuximab and retrospectively evaluated the presence of OM based on medical records. We collected information from 2 years of evaluations. Patient medical records were reviewed to obtain data on chemotherapy cycle and dose, sex, age, primary tumor, TNM stage, and head and neck radiotherapy (HNR) history. The X2 test and multinomial logistic regression were used for statistical analysis (SPSS 20.0, p < 0.05). Results: Among 1831 patients, OM was showed in 750 in any grade (41%), during cetuximab treatment. Most patients were female (n=944, 51.6%), <70years-old (n=1149, 62.8%), had larynx cancer (n=789, 43.1%) in T4 (n=579, 47.7%), N0 (n=509, 52.6%) stages. Primary tumor surgery was performed in 1476 (80.6%) patients, radiotherapy in 606 (33.1%) patients and cetuximab protocols most used involved up to four cycles (n=1072, 58.5%) of <400mg (n=996, 54.4%) cetuximab doses. Female (OR [odds ratio] = 2.17, CI95% = 1.26-3.75), >70 years-old patients (OR = 16.02, CI95% = 11.99-21.41), with HHNR (OR = 1.84, 1.41-2.40), treated with >4 cycles (OR = 1.52, CI95% = 1.16-2.01) and high doses of cetuximab (OR = 3.80, CI95% = 2.52-5.71) are the greatest risk factors for OM. Conclusions: Since the clinical benefit of cetuximab in the treatment of older patients is limited and there is a high OM, especially in women with head and neck treated with radiotherapy, high doses and a high number of cetuximab cycles must be administered with caution. (AU)

Genomic Surveillance of SARS-CoV-2 in Healthcare Workers: A Critical Sentinel Group for Monitoring the SARS-CoV-2 Variant Shift.

SARS-CoV-2 genome surveillance is important for monitoring risk groups and health workers as well as data on new cases and mortality rate due to COVID-19. We characterized the circulation of SARS-CoV-2 variants from May 2021 to April 2022 in the state of Santa Catarina, southern Brazil, and evaluated the similarity between variants present in the population and healthcare workers (HCW). A total of 5291 sequenced genomes demonstrated the circulation of 55 strains and four variants of concern (Alpha, Delta, Gamma and Omicron-sublineages BA.1 and BA.2). The number of cases was relatively low in May 2021, but the number of deaths was higher with the Gamma variant. There was a significant increase in both numbers between December 2021 and February 2022, peaking in mid-January 2022, when the Omicron variant dominated. After May 2021, two distinct variant groups (Delta and Omicron) were observed, equally distributed among the five Santa Catarina mesoregions. Moreover, from November 2021 to February 2022, similar variant profiles between HCW and the general population were observed, and a quicker shift from Delta to Omicron in HCW than in the general population. This demonstrates the importance of HCW as a sentinel group for monitoring disease trends in the general population.

Vórtex: uma representação cinematográfica atual da última etapa do ciclo da vida familiar / Vortex: a current cinematic representation of the last stage of the family life cycle / Vórtex: una representación cinematográfica actual de la última etapa del ciclo de vida familiar

O filme Vórtex, dirigido por Gaspar Noé e lançado em 2021, retrata o processo de final de vida de um casal que mora na França. A potência desta obra reside não só na correlação fiel da narrativa com os eventos reais do cotidiano, mas especialmente no modo sublime e sensível como a história é apresentada. É um espetáculo contemporâneo que permite elucidar dinâmicas familiares íntimas no estágio de terminalidade. Sendo assim, ergue-se como uma obra de grande valia para aqueles que cuidam de pessoas que estão morrendo, como profissionais de saúde, e suscita reflexões de foro social para o mundo pós-moderno.

The film Vortex, directed by Gaspar Noé and released in 2021, portrays the end-of-life process of a couple residing in France. The power of this work lies not only in the faithful correlation of the narrative with real everyday events, but especially in the sublime and sensitive way in which the story is presented. It is a contemporary show that allows to elucidate intimate family dynamics in the terminal stage. Therefore, it stands as a work of great value for those who care for people who are dying, such as healthcare professionals, and raises reflections of a social nature for the postmodern world.

La película Vórtex, dirigida por Gaspar Noé y estrenada en 2021, retrata el proceso del final de la vida de una pareja residente en Francia. El poder de esta obra reside no solo en la fiel correlación de la narración con hechos reales y cotidianos, sino especialmente en la manera sublime y sensible en que se presenta la historia. Es un espectáculo contemporáneo que nos permite dilucidar dinámicas familiares íntimas en la etapa terminal. Por tanto, se erige como una obra de gran valor para quienes atienden a las personas que están muriendo, como los profesionales de la salud, y suscita reflexiones de carácter social para el mundo posmoderno.

Melhores práticas no cuidado às pessoas que vivem com HIV em diferentes modelos de cuidado* / Mejores prácticas en la atención a personas viven con VIH en diferentes modelos de asistencia / Best practices in the care provided to people living with HIV in different care models

Objetivo: compreender os significados atribuídos às melhores práticas do cuidado às pessoas que vivem com HIV em dois diferentes modelos de cuidado em municípios prioritários do sul do Brasil. Método: Teoria Fundamentada nos Dados Construtivista, com 52 entrevistas em profundidade aplicadas em 2020 e 2021, para profissionais da atenção primária, especializada, gestores e pessoas que vivem com HIV. Resultados: o fenômeno "Significando as melhores práticas como gradativas e consistentes em diferentes municípios prioritários", permite compreender que no cuidado centralizado são desenvolvidas ações de prevenção e promoção da saúde, aconselhamento, diagnóstico precoce e encaminhamento, e no modelo descentralizado destaca-se a ampliação da clínica do enfermeiro e do médico de família no manejo da infecção, vinculação, longitudinalidade e integralidade. Conclusão: as melhores práticas em modelos distintos de cuidado requerem uma sucessão de diferentes momentos, que respeitem as falas dos profissionais e das pessoas que vivem com HIV.

Objective: to understand the meanings attributed to best practices in the care of people living with HIV in two different care models in priority municipalities from southern Brazil. Method: Constructivist Grounded Theory, with 52 in-depth interviews conducted in 2020 and 2021, involving professionals from primary and specialized care, managers and people living with HIV. Results: the phenomenon of "Signifying best practices as gradual and consistent across different priority municipalities" allows for an understanding that actions related to health prevention and promotion, counseling, early diagnosis and referral are developed in the centralized care model. In the decentralized model, the emphasis is on expanding the role of nurses and family physicians in infection management, establishing connections, ensuring care continuity, and providing comprehensive care. Conclusion: best practices in different care models require a succession of different moments that respect the perspectives and input of both health professionals and individuals living with HIV.

Objetivo: comprender los significados atribuidos a las mejores prácticas de atención a personas que viven con VIH en dos modelos de asistencia diferentes en municipios prioritarios del sur de Brasil. Método: Teoría Constructivista Fundamentada en los Datos, con 52 entrevistas en profundidad realizadas en 2020 y 2021, para profesionales de Atención Primaria y Especializada, administradores y personas que viven con VIH. Resultados: el fenómeno de "Representar las mejores prácticas como graduales y consistentes en diferentes municipios prioritarios" permite comprender que se desarrollan acciones relacionadas con prevención y promoción de la salud, asesoramiento, diagnóstico temprano y derivaciones en el modelo de atención descentralizado. En el modelo descentralizado, el énfasis radica en expandir el rol de los enfermeros y médicos de familia en el manejo de infecciones, establecer conexiones, garantizar continuidad de la atención y brindar asistencia integral. Conclusión: las mejores prácticas en distintos modelos de atención requieren cierta sucesión de diferentes momentos que deben respetar los discursos de los profesionales y las personas que viven con VIH.

Subjective cognitive decline in Brazil: Prevalence and association with dementia modifiable risk factors in a population-based study.

Introduction: Subjective cognitive decline (SCD) may be an early symptom of Alzheimer's disease. We aimed to estimate the prevalence of SCD in Brazil and its association with dementia modifiable risk factors. Methods: We used data of 8138 participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a population-based study that included clinical and demographic variables of individuals across the country. We calculated the prevalence of SCD and its association with dementia modifiable risk factors. Results: We found that the prevalence of SCD in Brazil was 29.21% (28.22%-30.21%), varying according to region, sex, and age. SCD was strongly associated with hearing loss, low education, psychological distress, Brown/Pardo and Black races. Discussion: The prevalence of SCD in Brazil is higher than in high-income countries. Brown/Black races and dementia modifiable risk factors were associated with SCD. Public strategies that target SCD may help mitigate the incidence of dementia.

A new RT-LAMP-on-a-Chip Instrument for SARS-CoV-2 diagnostics.

This work describes the development of a Point-of-Care (POC) Lab-on-a-Chip (LOC) instrument for diagnosis of SARS-CoV-2 by Reverse-Transcription Loop-mediated isothermal amplification (RT-LAMP). The hardware is based on a Raspberry Pi computer ($35), a video camera, an Arduino Nano microcontroller, a printed circuit board as a heater and a 3D printed housing. The chips were manufactured in polymethyl methacrylate (PMMA) using a CO2 laser cutting machine and sealed with a PCR optic plastic film. The chip temperature is precisely controlled by a proportional-integral-derivative (PID) algorithm. During the RT-LAMP amplifications the chip was maintained at ∼ (65.0 ± 0.1) °C for 25 minutes and 5 minutes cooling down, totaling a 30 minutes of reaction .The software interpretation occurs in less than a second. The chip design has four 25 µL chambers, two for clinical samples and two for positive and negative control-samples. The RT-LAMP master mix solution added in the chip chambers contains the pH indicator Phenol Red, that is pink (for pH ∼ 8.0) before amplification and becomes yellow (pH ∼ 6.0) if the genetic material is amplified. The RT-LAMP SARS-CoV-2 diagnostic was made by color image recognition using the OpenCV machine vision software library. The software was programmed to automatically distinguish the HSV color parameter distribution in each one of the four chip chambers. The instrument was successfully tested for SARS-CoV-2 diagnosis, in 22 clinic samples, 11 positives and 11 negatives, achieving an assertiveness of 86% when compared to the results obtained by RT-LAMP standard reactions performed in conventional PCR equipment.

Emergence of Two Distinct SARS-CoV-2 Gamma Variants and the Rapid Spread of P.1-like-II SARS-CoV-2 during the Second Wave of COVID-19 in Santa Catarina, Southern Brazil.

The western mesoregion of the state of Santa Catarina (SC), Southern Brazil, was heavily affected as a whole by the COVID-19 pandemic in early 2021. This study aimed to evaluate the dynamics of the SARS-CoV-2 virus spreading patterns in the SC state from March 2020 to April 2021 using genomic surveillance. During this period, there were 23 distinct variants, including Beta and Gamma, among which the Gamma and related lineages were predominant in the second pandemic wave within SC. A regionalization of P.1-like-II in the Western SC region was observed, concomitant to the increase in cases, mortality, and the case fatality rate (CFR) index. This is the first evidence of the regionalization of the SARS-CoV-2 transmission in SC and it highlights the importance of tracking the variants, dispersion, and impact of SARS-CoV-2 on the public health systems.

Fluorescent and colorimetric RT-LAMP as a rapid and specific qualitative method for chronic myeloid leukemia diagnosis.

The detection of BCR-ABL1 mRNA transcripts is essential to molecular chronic myeloid leukemia (CML) diagnosis. In most cases, the RT-qPCR technique is performed as the gold standard diagnosis tool for clinical cases. However, this method requires expensive reagents and equipment, such as a real-time thermal cycler, probes and master mix. Consequently, the development and validation of simple and low-cost methods are essential for a rapid CML diagnosis in less specialized and equipped centers. In this study, we develop and demonstrate an accessible, rapid, and low-cost method using RT-LAMP for BCR-ABL1 detection in both cell lines and CML clinical samples, using fluorescent and colorimetric assays. Both methods demonstrated diagnostic specificity of 100% and while diagnostic sensitivity reaches more than 90% in samples with RT-qPCR cycle threshold above 31. The obtained data indicates that the proposed method here described is robust, specific and rapid approach for CML diagnosis with outstanding performance, especially for CML diagnostic procedure where present high BCR-ABL1 expression.

Aplicativos móveis para enfrentamento da tuberculose: uma prospecção tecnológica / Mobile applications to face tuberculosis: a technological prospect / Aplicaciones móviles para combatir la tuberculosis: una perspectiva tecnológica

Objetivo: identificar aplicativos móveis disponíveis para monitoramento da tuberculose e suas contribuições para o seu enfrentamento. Método: prospecção diagnóstica, realizada com busca nas plataformas App Store® e Google Play Store®. A coleta de dados ocorreu em abril de 2021, utilizando os termos "Tuberculose", "Tuberculosis" e "Tuberculosis", em português, espanhol e inglês. A extração, organização e tabulação dos dados foi por meio da ferramenta Microsoft Excel® 2016. Resultados: a busca resultou em 24 aplicativos na App Store® e 510 na Google Play Store®. Após aplicação dos critérios de inclusão e exclusão, 42 aplicativos foram analisados e categorizados em aplicativos voltados ao público geral e aplicativos voltados para informações aos profissionais de saúde. Conclusão: a prospecção possibilitou conhecer o estado da arte dos aplicativos para tuberculose, identificando-se a importância da interatividade das interfaces, dos recursos de lembretes para uso adequado das medicações e dos espaços para dúvidas frequentes e troca de experiências

Objective: to identify the mobile applications available for tuberculosis monitoring and their contributions to its coping. Method: diagnostic prospection, carried out with a search on the App Store® and Google Play Store® platforms. Data collection took place in April 2021, using the terms "Tuberculosis", "Tuberculosis" and "Tuberculosis", in Portuguese, Spanish and English. Data extraction, organization and tabulation was done using the Microsoft Excel® 2016 tool. Results: the search resulted in 24 applications in the App Store® and 510 in the Google Play Store®. After applying the inclusion and exclusion criteria, 42 applications were analyzed and categorized into applications aimed at the general public and applications aimed at providing information to health professionals. Conclusion: the prospection made it possible to know the state of the art of applications for tuberculosis, identifying the importance of the interactivity of the interfaces, of the resources of reminders for the proper use of the medications and of the spaces for frequent doubts and exchange of experiences

Objetivo: identificar las aplicaciones móviles disponibles para el seguimiento de la tuberculosis y sus aportes para combatirla. Método: prospección diagnóstica, realizada con búsqueda en las plataformas App Store® y Google Play Store®. La recolección de datos ocurrió en abril de 2021, utilizando los términos "Tuberculosis", "Tuberculosis" y "Tuberculosis", en portugués, español e inglés. La extracción, organización y tabulación de los datos se realizó mediante la herramienta Microsoft Excel® 2016. Resultados: la búsqueda arrojó 24 aplicaciones en App Store® y 510 en Google Play Store®. Después de aplicar los criterios de inclusión y exclusión, se analizaron 42 aplicaciones y se clasificaron en aplicaciones dirigidas al público en general y aplicaciones destinadas a brindar información a los profesionales de la salud. Conclusión: la prospección posibilitó conocer el estado del arte de las aplicaciones para la tuberculosis, identificando la importancia de la interactividad de las interfaces, de los recursos de recordatorios para el uso adecuado de los medicamentos y de los espacios de dudas frecuentes e intercambio de experiencias

Machine learning analysis to predict health outcomes among emergency department users in Southern Brazil: a protocol study.

OBJECTIVE: Emergency services are essential to the organization of the health care system. Nevertheless, they face different operational difficulties, including overcrowded services, largely explained by their inappropriate use and the repeated visits from users. Although a known situation, information on the theme is scarce in Brazil, particularly regarding longitudinal user monitoring. Thus, this project aims to evaluate the predictive performance of different machine learning algorithms to estimate the inappropriate and repeated use of emergency services and mortality. METHODS: To that end, a study will be conducted in the municipality of Pelotas, Rio Grande do Sul, with around five thousand users of the municipal emergency department. RESULTS: If the study is successful, we will provide an algorithm that could be used in clinical practice to assist health professionals in decision-making within hospitals. Different knowledge dissemination strategies will be used to increase the capacity of the study to produce innovations for the organization of the health system and services. CONCLUSION: A high performance predictive model may be able to help decisionmaking in the emergency services, improving quality of care.

Colorimetric RT-LAMP SARS-CoV-2 diagnostic sensitivity relies on color interpretation and viral load.

The use of RT-LAMP (reverse transcriptase-loop mediated isothermal amplification) has been considered as a promising point-of-care method to diagnose COVID-19. In this manuscript we show that the RT-LAMP reaction has a sensitivity of only 200 RNA virus copies, with a color change from pink to yellow occurring in 100% of the 62 clinical samples tested positive by RT-qPCR. We also demonstrated that this reaction is 100% specific for SARS-CoV-2 after testing 57 clinical samples infected with dozens of different respiratory viruses and 74 individuals without any viral infection. Although the majority of manuscripts recently published using this technique describe only the presence of two-color states (pink = negative and yellow = positive), we verified by naked-eye and absorbance measurements that there is an evident third color cluster (orange), in general related to positive samples with low viral loads, but which cannot be defined as positive or negative by the naked eye. Orange colors should be repeated or tested by RT-qPCR to avoid a false diagnostic. RT-LAMP is therefore very reliable for samples with a RT-qPCR Ct < 30 being as sensitive and specific as a RT-qPCR test. All reactions were performed in 30 min at 65 °C. The use of reaction time longer than 30 min is also not recommended since nonspecific amplifications may cause false positives.

Essential properties and pitfalls of colorimetric Reverse Transcription Loop-mediated Isothermal Amplification as a point-of-care test for SARS-CoV-2 diagnosis.

BACKGROUND: SARS-CoV-2 Reverse Transcription Loop-mediated Isothermal Amplification (RT-LAMP) colorimetric detection is a sensitive and specific point-of-care molecular biology technique used to detect the virus in only 30 min. In this manuscript we have described a few nuances of the technique still not properly described in the literature: the presence of three colors clusters; the correlation of the viral load with the color change; and the importance of using an internal control to avoid false-negative results. METHODS: To achieve these findings, we performed colorimetric RT-LAMP assays of 466 SARS-CoV-2 RT-qPCR validated clinical samples, with color quantification measured at 434 nm and 560 nm. RESULTS: First we determinate a sensitivity of 93.8% and specificity of 90.4%. In addition to the pink (negative) and yellow (positive) produced colors, we report for the first time the presence of an orange color cluster that may lead to wrong diagnosis. We also demonstrated using RT-qPCR and RT-LAMP that low viral loads are related to Ct values > 30, resulting in orange colors. We also demonstrated that the diagnosis of COVID-19 by colorimetric RT-LAMP is efficient until the fifth symptoms day when the viral load is still relatively high. CONCLUSION: This study reports properties and indications for colorimetric RT-LAMP as point-of-care for SARS-CoV-2 diagnostic, reducing false results, interpretations and optimizing molecular diagnostics tests application.

Estratégias para sustentar o interesse em realizar residência médica em Medicina de Família e Comunidade durante tempos de pandemia de COVID-19 no contexto brasileiro / Strategies to support interest in doing medical residency in Family Medicine during times of the COVID-19 pandemic in the Brazilian context / Estrategias para mantener el interés en realizar la residencia médica en Medicina Familiar y Comunitaria en tiempos de la pandemia COVID-19 en el contexto brasileño

A residência médica é considerada o padrão-ouro na formação de especialistas em Medicina de Família e Comunidade. Há uma alta demanda por profissionais adequadamente qualificados nessa área no contexto brasileiro. No entanto, essa residência ainda se mostra pouco atrativa para boa parte dos egressos de Medicina, fato revelado pelas inúmeras vagas ociosas e altas taxas de desistência a despeito de seriadas tentativas de torná-la mais motivante para o candidato. A pandemia intensificou ainda mais esse desinteresse e há sinais de que ela persistirá em 2021. Assim, torna-se necessário e urgente buscar novas estratégias. Entre as alternativas que podem combater esse desânimo estão a reestruturação de ambientes de ensino virtual e a redistribuição da carga horária dos residentes.

Medical residency is considered the gold standard in the training of specialists in Family Medicine. There is a high demand for suitably qualified professionals in this area in the Brazilian context. However, this residency is still unattractive to most medical graduates, a fact revealed by the countless vacant vacancies and high dropout rates despite serious attempts to make it more motivating for the candidate. The pandemic has further intensified this lack of interest and there are signs that it will persist in 2021. Thus, it is necessary and urgent to seek new strategies. Among the alternatives that can combat this discouragement are the restructuring of virtual teaching environments and the redistribution of residents' workload.

La residencia médica se considera el estándar de oro en la formación de especialistas en Medicina Familiar y Comunitaria. Existe una gran demanda de profesionales debidamente calificados en esta área en el contexto brasileño. Sin embargo, esta residencia sigue siendo poco atractiva para la mayoría de los graduados de medicina, un hecho revelado por las innumerables vacantes y las altas tasas de deserción a pesar de los serios intentos de que sea más motivadora para el candidato. La pandemia ha intensificado aún más este desinterés y hay indicios de que persistirá en 2021. Por ello, es necesario y urgente buscar nuevas estrategias. Entre las alternativas que pueden combatir este desánimo se encuentran la reestructuración de los entornos de enseñanza virtual y la redistribución de la carga de trabajo de los residentes.

Machine learning analysis to predict health outcomes among emergency department users in Southern Brazil: a protocol study / Análise de aprendizado de máquina para prever resultados de saúde entre usuários de serviços de emergência no sul do Brasil: estudo de protocolo

ABSTRACT: Objective: Emergency services are essential to the organization of the health care system. Nevertheless, they face different operational difficulties, including overcrowded services, largely explained by their inappropriate use and the repeated visits from users. Although a known situation, information on the theme is scarce in Brazil, particularly regarding longitudinal user monitoring. Thus, this project aims to evaluate the predictive performance of different machine learning algorithms to estimate the inappropriate and repeated use of emergency services and mortality. Methods: To that end, a study will be conducted in the municipality of Pelotas, Rio Grande do Sul, with around five thousand users of the municipal emergency department. Results: If the study is successful, we will provide an algorithm that could be used in clinical practice to assist health professionals in decision-making within hospitals. Different knowledge dissemination strategies will be used to increase the capacity of the study to produce innovations for the organization of the health system and services. Conclusion: A high performance predictive model may be able to help decisionmaking in the emergency services, improving quality of care.

RESUMO: Objetivo: Os serviços de emergência são fundamentais na organização da rede de atenção à saúde. Não obstante, apresentam diferentes dificuldades para seu funcionamento. Entre essas, destaca-se a superlotação dos serviços, a qual, em boa medida, é explicada pelo uso inadequado do serviço e reutilização frequente por parte de usuários. Apesar do conhecimento dessa situação, as informações sobre a temática são escassas no Brasil, ainda mais as relacionadas ao acompanhamento longitudinal dos usuários. Assim, este projeto objetiva avaliar a performance preditiva de diferentes algoritmos de machine learning para estimar o uso inapropriado e a reutilização dos serviços de emergência e a mortalidade. Métodos: Para isso, será realizado um estudo no município de Pelotas, Rio Grande do Sul, com um pouco mais de cinco mil usuários do pronto socorro municipal. Resultados: Caso o estudo seja bem-sucedido, será disponibilizado um algoritmo com potencial para ser usado na prática clínica para auxiliar profissionais de saúde na tomada de decisão no contexto hospitalar. Diferentes estratégias de difusão dos conhecimentos serão utilizadas para aumentar a capacidade do estudo de produzir inovações para a organização do sistema e serviços de saúde. Conclusão: Um modelo preditivo de alto desempenho pode auxiliar na tomada de decisão nos serviços de emergência, melhorando a qualidade do atendimento.

Impactos físicos e psicológicos na população de Brumadinho após rompimento da barragem de rejeitos / Physical and psychological impacts on the population of Brumadinho after rupture of the tailings dam

Objetivo: Esta revisão sistemática busca identificar os fatores que podem impactar na saúde das vítimas do rompimento da barragem, em especial aqueles riscos surgidos ou incrementados com a ruptura da barragem de rejeitos em Brumadinho. Fontes de Dados: Bases de dados informatizadas, Pubmed, Scopus e Web of Science nos idiomas Português e Inglês, restringindo-se a publicações nos últimos cinco anos. Critérios de inclusão: estudos que abordem aspectos relacionados à saúde dos envolvidos na ruptura da barragem de Brumadinho. Foram excluídos estudos que abordassem qualquer tema que escapasse desse escopo. Síntese dos Dados: Foram identificadas um total de 157 publicações. Excluíram-se 127 pelo título, por serem duplicatas e pelos critérios de exclusão. Analisou-se 30 integralmente, restando 19(63,3%). Resultados: Por meio dos critérios de elegibilidade dessa revisão foram encontrados artigos sobre as consequências do achado de metais pesados nas águas dos rios, como o favorecimento de genes multirresistentes e o comprometimento de fonte de água potável. Também foram descritos os impactos na saúde mental em Brumadinho, pois nota-se que a população está sujeita a efeitos psicológicos traumáticos secundários a desastres ambientais. Por meio dessa busca foi identificado que ainda há a necessidade de novos estudos sobre os impactos da mudança da morfologia hídrica e social para a saúde desses indivíduos. Conclusão:Alguns poucos impactos diretos e indiretos já estão descritos na literatura de forma incipiente, de forma que ações de mitigação são necessárias para dirimir os impactos já observados.

Abstract: This systematic review seeks to identify the factors that may impact on the health of the victims of the dam rupture, especially those risks arising or increased with the rupture of the tailings dam in Brumadinho. Data Sources: Computerized databases, Pubmed, Scopus and Web of Science in Portuguese and English, restricted to publications from the last five years. Inclusion criteria: studies that address aspects related to the health of those involved in the Brumadinho dam rupture. Studies that addressed any topic that fell outside this scope were excluded. Summary of Data: A total of 157 publications were identified. 127 were excluded by title, because they are duplicates and by exclusion criteria. 30 were analyzed in full and, of these, only 19 (63,3%) were eligible. Results: Through the eligibility criteria of this review, articles were found on the consequences of the finding of heavy metals in river waters, such as the favoring of multidrug-resistant genes and the impairment of drinking water sources. The impacts on mental health in Brumadinho were also described, it is noted that the population is subject to traumatic psychological effects secondary to environmental disasters. Through this search, it was identified that there is still a need for further studies on the impacts of changing water and social morphology on the health of these individuals. Conclusion: Direct and indirect impacts are shown and that actions are fundamental for their mitigation.

Detecção e quantificação de bactérias resistentes aos antibióticos ampicilina e cloranfenicol em estações de tratamento de esgoto doméstico / Detection and quantification of bacteria resistant to ampicillin and chloranphenicol in domestic sewage treatment plants

RESUMO Estações de tratamento de esgotos (ETEs) estão entre as principais fontes de disseminação de bactérias resistentes a antibióticos (BRAs) e genes de resistência (GRAs) no ambiente. Este trabalho quantificou a ocorrência de bactérias resistentes aos antibióticos ampicilina e cloranfenicol no esgoto bruto (EB), no efluente tratado (ET) e no lodo de duas ETEs em escala plena por um período de nove meses. As unidades investigadas utilizavam os seguintes sistemas de tratamento: ETE-A, sistema de lodos ativados convencional; e a ETE-B, reatores anaeróbios (UASB) seguidos de filtros biológicos percoladores (FBP). Os resultados evidenciaram que a ETE-A foi mais eficiente na redução das concentrações de bactérias resistentes à ampicilina e ao cloranfenicol (cerca de 1,1 e 0,7 log10UFC.mL−1 de remoção, respectivamente), quando comparada com a ETE-B (0,5log10 UFC.mL−1 de remoção para as bactérias resistentes ao cloranfenicol e nenhuma remoção para as resistentes à ampicilina). As amostras de lodo, de ambas ETEs, apresentaram elevadas concentrações de bactérias heterotróficas totais — BHTs (4,8-7,6 log10UFC.mL−1) e de BRAs (3,0-6,3 log10UFC.mL−1). A maioria das cepas resistentes à ampicilina e ao cloranfenicol isoladas foi identificada como sendo da família Enterobacteriaceae. Algumas das espécies identificadas são bactérias potencialmente patogênicas, tais como: Klebsiella pneumoniae, Aeromonas hydrophila, Escherichia coli, Enterococcus faecium, Salmonella spp. Os resultados chamam a atenção para a disseminação de BRAs, potencialmente patogênicas, no meio ambiente a partir do efluente final (proveniente do tratamento secundário) das ETEs, independentemente do tipo de sistema adotado. Fica evidente que para reduzir significativamente a concentração das BRAs no ET, este deveria passar por tratamento adicional e desinfecção.

ABSTRACT Sewage treatment plants (STP) are among the main sources of dissemination of antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARG) into the environment. This work quantified the occurrence of cultivable ampicilin-resistant and chloramphenicol-resistant bacteria in raw sewage, treated effluent and sludge samples from two full-scale STP over nine months. The STP investigated used the following treatment systems: STP-A used conventional activated sludge system; and STP-B, anaerobic reactors (UASB) followed by percolating biological filters (PBF). Results showed that was more efficient in reducing the concentrations of ampicilin- and chloramphenicol-resistant bacteria (around 1.1 and 0.7 log10UFC.mL−1, respectively) when compared to STP-B (0.5 log10 UFC.mL−1 removal of cloramphenicol-resistant bacteria and no-removal of ampicilin-resistant bacteria). Sludge samples, from both STP, showed high concentrations of total heterotrophic bacteria (THB; 4.8-7.6 log10UFC.mL−1) and ARB (3.0-6.3 log10UFC.mL−1). Most of the isolated ampicilin- and chloramphenicol-resistant strains were identified as members of the Enterobacteriaceae family. Some of the identified species are potential pathogenic bacteria, such as Klebsiella pneumoniae, Aeromonas hydrophila, Escherichia coli, Enterococcus faecium, Salmonella spp. These results call attention to the spread of ARB, potentially pathogenic, in the environment from the final effluent (from secondary effluent) on the STP, regardless of the type of system adopted. It is evident that in order to significantly reduce the concentration of ARB in the treated effluent, it should undergo additional treatment and disinfection.

Inconsistent effects of gluten on obesity: is there a role for the haptoglobin isoforms?

BACKGROUND AND AIMS: There is no clear evidence about the effects of gluten intake on obesity. It is known that gluten's effects on gut permeability are mediated by zonulin, a protein identified as pre-haptoglobin 2, a physiological regulator of the intestinal barrier. We investigated the obesogenic and inflammatory effects of gluten and its association with the haptoglobin genotype. METHODS: This was a single blinded, crossover study, including 40 overweight or obesity women free of celiac disease. Participants adopted a gluten-free diet (GFD) for 8 weeks and consumed a gluten-free muffin (GF-M) or a gluten-containing muffin (GLU-M, 24 g gluten) for 4 weeks, switching muffin type during the subsequent 4 weeks. During a follow-up period of 4 weeks we evaluated the usual diet (UD). Food diaries were collected to estimate the macronutrient intake and dietary inflammatory index (DII®). Bodyweight and composition, resting energy expenditure (REE), and cytokines were assessed. Haptoglobin alleles (Hp1 and Hp2) were genotyped to characterize zonulin expression. RESULTS: Energy and macronutrient intakes were similar during both periods, except for protein intake, which was higher during GLU-M. DII scores indicated a more inflammatory profile during the GF-M and GLU-M periods compared to UD. No differences were observed in body composition or REE between interventions when the Hp genotype was not considered. Nonetheless, those carrying the Hp2-2 genotype (overexpressing zonulin) presented lower REE and higher levels of IL6 and IL1beta only during gluten intake (GLU-M and UD) compared to age- and body mass index-matched Hp1-1 carrier. These results suggest an obesogenic and inflammatory action of gluten only in those overexpressing zonulin (Hp2-2). CONCLUSION: These results highlight the importance of zonulin as the mediator of gluten obesogenic and inflammatory effects. Our data suggest that in the presence of gluten, zonulin release is associated with a reduction of REE and an increase of inflammatory markers that are not seen in zonulin low producers.

Mixed-type intraductal papillary mucinous neoplasm: Tailored surgical planning - case report.

INTRODUCTION: With the greater availability of imaging exams, the diagnosis of intraductal papillary mucinous neoplasms (IPMNs) has increased recently. However, there are still questions about adequate management approaches for this disease, especially regarding the best therapeutic strategy. The objective is to describe the case of a patient with mixed-type (MT) IPMN successfully treated by a tailored surgical plan that adopted duodenopancreatectomy and imaging to monitor the remaining lesions of the tail and body of the pancreas. PRESENTATION OF CASE: A 65-year-old asymptomatic man underwent ultrasonography of the abdomen and was diagnosed with a cystic tumor, measuring 3.0 × 2.5 cm, located on the head of the pancreas. Magnetic resonance cholangiopancreatography (MRCP) showed dilation of the main pancreatic duct and multiple cystic lesions scattered throughout the entire parenchyma. The patient underwent duodenopancreatectomy; postoperatively, he did not have complications and was discharged on the 6th postoperative day. The histopathological panel confirmed the presence of MT-IPMN of the intestinal pattern. The patient is currently well four years after surgery and is undergoing semiannual MRCP examinations to follow up the remaining lesions. DISCUSSION: MT-IPMNs represent 28-41% of all IPMNs. Among all subtypes, MT-IPMNs are the most challenging in terms of choosing the ideal therapeutic strategy. These lesions are the most difficult to treat because they can be multifocal and compromise different locations of the pancreatic parenchyma. CONCLUSION: MRI findings, Ca19.9 serum level and negative family history of pancreatic neoplasia were indications for the surgical choice for the MT- IPMN presented in this case.

In Vitro Probiotic Properties and DNA Protection Activity of Yeast and Lactic Acid Bacteria Isolated from A Honey-Based Kefir Beverage.

The probiotic characteristics of three acid-tolerant microbial strains, viz., Lactobacillus satsumensis LPBF1, Leuconostoc mesenteroides LPBF2 and Saccharomyes cerevisiae LPBF3, isolated from a honey-based kefir functional beverage, were studied following the requirements established by the Food and Agriculture Organization of the United Nation/World Health Organization (FAO/WHO), including host-associated stress resistance, epithelium adhesion ability, and antimicrobial activity. The three microbial strains tolerated different pH values (2.0, 3.0, 4.0 and 7.0) and bile salt concentrations (0.3% and 0.6%), and survive in the presence of simulated gastric juice, which are conditions imposed by the gastrointestinal tract. In addition, they showed high percentages of hydrophobicity, auto aggregation and anti-pathogenic against Escherichia coli and Staphylococcus aureus, with no hemolytic activity. The protective capacity of human DNA through microbial treatment was investigated by single-cell gel electrophoresis (SCGE) comet assay. The three selected strains showed DNA protection effect against damage caused by hydroxyl radical (H2O2). However, when the S. cerevisiae treatment was applied, the most effective DNA protection index was observed, which can be associated to its high production of extracellular antioxidants as reveled by the 2,2-diphenyl-1-picryl-hydrazylhydrate (DPPH) method. These results indicated that the three selected microbial strains could be useful for preventing oxidative DNA damage and cellular oxidation in food products. As well-adapted microbial cells, the selected strains can be used for production of non-dairy functional beverages, especially for vegans and/or vegetarians and lactose intolerants.

Care sharing for people with HIV/AIDS: a look targeted at young adults / La distribución del cuidado de la persona con VIH/Sida: una mirada hacia el adulto joven / Compartilhamento do cuidado da pessoa com HIV/Aids: olhar direcionado ao adulto jovem

ABSTRACT Objective: To understand the care sharing for people living with HIV/AIDS, especially young adults, as well as the structuring of the line of care in the capital of Santa Catarina. Method: Qualitative research, anchored by theory based on data collected in the Health Care Network of Florianópolis, totaling 19 participants distributed between two sample groups. The data collection and analysis were concomitant, with comparative analysis method. Results: The municipality has been transitioning in the health care model for people with HIV/AIDS, especially young adults, whose care is shared within the Health Care Network. Final considerations: In the municipality, there is the inclusion of management of HIV in primary health care services along with the establishment of a more resolutive care model. Thus, the care of this population is shared in different points of the health care network.

RESUMEN Objetivo: Comprender la distribución del cuidado a la persona con convive con VIH/Sida, enfocándose en el adulto joven y en la estructuración de una línea de cuidado en la capital catarinense (Brasil). Método: Investigación cualitativa, con base en la teoría fundamentada en los datos, que fueron recolectados en la Red de Atención a la Salud de Florianópolis, con un total de 19 participantes distribuidos en dos grupos de muestreo. La recolección de los datos y su análisis fueron simultáneos al análisis comparativo. Resultados: El municipio en cuestión pasa por la transición en el modelo de atención ofertado a las personas con VIH/Sida, principalmente a los adultos jóvenes, quienes reciben un cuidado que se distribuye dentro de la Red de Atención a la Salud. Consideraciones finales: En el municipio en cuestión, hay la inclusión del manejo del VIH en los servicios de atención primaria, al mismo tiempo que el establecimiento del modelo asistencial matricial y más resolutivo. De esta forma, el cuidado de esta población está distribuido en los diferentes aspectos de la red de atención a la salud.

RESUMO Objetivo: Compreender o compartilhamento do cuidado à pessoa vivendo com HIV/Aids, com destaque ao adulto jovem e à estruturação de linha de cuidado na capital catarinense. Método: Pesquisa qualitativa, ancorada pela teoria fundamentada nos dados, os quais foram coletados na Rede de Atenção à Saúde de Florianópolis, totalizando 19 participantes distribuídos em dois grupos amostrais. A coleta e a análise dos dados se deram concomitantemente, com método de análise comparativa. Resultados: O município de estudo passa por transição no modelo de atenção às pessoas com HIV/Aids, em especial aos adultos jovens, cujo cuidado se compartilha dentro da Rede de Atenção à Saúde. Considerações finais: No município de estudo, tem-se a inclusão do manejo do HIV nos serviços da atenção primária, concomitantemente ao estabelecimento de modelo assistencial matriciado e mais resolutivo. Desta forma, o cuidado desta população compartilha-se nos diferentes pontos da rede de atenção à saúde.